{"id":1231,"date":"2019-12-29T19:53:46","date_gmt":"2019-12-30T00:53:46","guid":{"rendered":"https:\/\/cphsystems.org\/car-seats\/?page_id=1231"},"modified":"2021-02-26T16:57:30","modified_gmt":"2021-02-26T21:57:30","slug":"user-registration","status":"publish","type":"page","link":"https:\/\/cphsystems.org\/car-seats\/register-for-a-class\/user-registration\/","title":{"rendered":"User Registration"},"content":{"rendered":"<p>[vc_row row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;full_width&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221; css_animation=&#8221;&#8221; css=&#8221;.vc_custom_1614376279880{padding-top: 50px !important;padding-right: 50px !important;padding-bottom: 50px !important;padding-left: 50px !important;background-color: #ffffff !important;}&#8221;][vc_column][vc_column_text]<h3>You selected: <\/h3>[\/vc_column_text][\/vc_column][\/vc_row][vc_row row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;full_width&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221; css_animation=&#8221;&#8221; css=&#8221;.vc_custom_1614376648238{margin-top: 0px !important;padding-right: 50px !important;padding-bottom: 50px !important;padding-left: 50px !important;background-color: #ffffff !important;}&#8221;][vc_column][vc_column_text]<div class=\"frm_forms  with_frm_style frm_style_big_text\" id=\"frm_form_6_container\" ><form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_t66i\" ><div class=\"frm_form_fields \"><fieldset><legend class=\"frm_hidden\">Registrant Information<\/legend><div class=\"frm_fields_container\"><input type=\"hidden\" name=\"frm_action\" value=\"create\" \/><input type=\"hidden\" name=\"form_id\" value=\"6\" \/><input type=\"hidden\" name=\"frm_hide_fields_6\" id=\"frm_hide_fields_6\" value=\"\" \/><input type=\"hidden\" name=\"form_key\" value=\"t66i\" \/><input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/><input type=\"hidden\" id=\"frm_submit_entry_6\" name=\"frm_submit_entry_6\" value=\"39bf0df297\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/car-seats\/wp-json\/wp\/v2\/pages\/1231\" \/><input type=\"hidden\" name=\"item_meta[147]\" id=\"field_yv757\" value=\"\" \/><input type=\"hidden\" name=\"item_meta[281]\" id=\"field_tch3w\" value=\"04\/19\/2024\"  data-frmval=\"04\/19\/2024\"   \/><input type=\"hidden\" name=\"item_meta[323]\" id=\"field_v068j-0\" value=\"\" \/><div id=\"frm_field_402_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first vertical_radio\"><div  id=\"field_xwl1s_label\" class=\"frm_primary_label\">I am scheduling this appointment for...<span class=\"frm_required\" aria-hidden=\"true\">*<\/span><\/div><div class=\"frm_opt_container\" aria-labelledby=\"field_xwl1s_label\" role=\"radiogroup\" aria-required=\"true\"><div class=\"frm_radio\" id=\"frm_radio_402-0\"><label  for=\"field_xwl1s-0\"><input type=\"radio\" name=\"item_meta[402]\" id=\"field_xwl1s-0\" value=\"Myself\"   data-reqmsg=\"I am scheduling this appointment for... cannot be blank.\" data-invmsg=\"I am scheduling this appointment for... is invalid\" aria-invalid=\"false\"  \/> Myself<\/label><\/div><div class=\"frm_radio\" id=\"frm_radio_402-1\"><label  for=\"field_xwl1s-1\"><input type=\"radio\" name=\"item_meta[402]\" id=\"field_xwl1s-1\" value=\"Someone Else\"   data-reqmsg=\"I am scheduling this appointment for... cannot be blank.\" data-invmsg=\"I am scheduling this appointment for... is invalid\" aria-invalid=\"false\"  \/> Someone Else<\/label><\/div><\/div><\/div><div id=\"frm_field_356_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\"><label for=\"field_hzoo\" id=\"field_hzoo_label\" class=\"frm_primary_label\">Preferred Time<span class=\"frm_required\">*<\/span><\/label><select name=\"item_meta[356]\" id=\"field_hzoo\"  data-reqmsg=\"Preferred Time cannot be blank.\" aria-required=\"true\" data-invmsg=\"Preferred Time is invalid\" aria-invalid=\"false\"  ><option  value=\"\" selected='selected'> <\/option><option  value=\"10:00 AM\">10:00 AM<\/option><option  value=\"10:30 AM\">10:30 AM<\/option><option  value=\"11:00 AM\">11:00 AM<\/option><option  value=\"11:30 AM\">11:30 AM<\/option><option  value=\"12:00 PM\">12:00 PM<\/option><option  value=\"12:30 PM\">12:30 PM<\/option><option  value=\"13:00 PM\">01:00 PM<\/option><option  value=\"13:30 PM\">01:30 PM<\/option><option  value=\"14:00 PM\">02:00 PM<\/option><\/select><\/div><div id=\"frm_field_406_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_first\"><label for=\"field_8tsgq\" id=\"field_8tsgq_label\" class=\"frm_primary_label\">Your Name (First and Last)<span class=\"frm_required\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"field_8tsgq\" name=\"item_meta[406]\" value=\"\"  data-reqmsg=\"Your Name (First and Last) cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><\/div><div id=\"frm_field_404_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4\"><label for=\"field_8q1hv\" id=\"field_8q1hv_label\" class=\"frm_primary_label\">Agency\/Program\/Relation<span class=\"frm_required\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"field_8q1hv\" name=\"item_meta[404]\" value=\"\"  data-reqmsg=\"Agency\/Program\/Relation cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><\/div><div id=\"frm_field_405_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4\"><label for=\"field_wkmix\" id=\"field_wkmix_label\" class=\"frm_primary_label\">Email<span class=\"frm_required\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"field_wkmix\" name=\"item_meta[405]\" value=\"\"  data-reqmsg=\"Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/><\/div><div id=\"frm_field_89_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\"><h3 class=\"frm_pos_top frm_section_spacing\">Registrant Information<\/h3><div id=\"frm_field_68_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\"><label for=\"field_la6yz\" class=\"frm_primary_label\">First Name<span class=\"frm_required\">*<\/span><\/label><input type=\"text\" id=\"field_la6yz\" name=\"item_meta[68]\" value=\"\"  data-sectionid=\"89\"  data-reqmsg=\"First Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"First Name is invalid\" aria-invalid=\"false\"  \/><\/div><div id=\"frm_field_69_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\"><label for=\"field_ouch0\" class=\"frm_primary_label\">Last Name<span class=\"frm_required\">*<\/span><\/label><input type=\"text\" id=\"field_ouch0\" name=\"item_meta[69]\" value=\"\"  data-sectionid=\"89\"  data-reqmsg=\"Last Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Last Name is invalid\" aria-invalid=\"false\"  \/><\/div><div id=\"frm_field_276_container\" class=\"frm_form_field form-field  frm_top_container frm_third frm_other_container\"><label for=\"field_c0w8n\" id=\"field_c0w8n_label\" class=\"frm_primary_label\">Relation to Child<span class=\"frm_required\"><\/span><\/label><select name=\"item_meta[276]\" id=\"field_c0w8n\"  data-sectionid=\"89\"  data-invmsg=\"Relation to Child is invalid\" aria-invalid=\"false\"  ><option  value=\"\" selected='selected'> <\/option><option  value=\"Mother\">Mother<\/option><option  value=\"Father\">Father<\/option><option  value=\"Legal Guardian\">Legal Guardian<\/option><option  value=\"Other\" class=\"frm_other_trigger\">Other<\/option><\/select><label for=\"field_c0w8n-otext\" class=\"frm_screen_reader frm_hidden\">Relation to Child<\/label><input type=\"text\" id=\"field_c0w8n-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][276]\" value=\"\" \/><\/div><div id=\"frm_field_270_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third frm_other_container\"><label for=\"field_2neca\" id=\"field_2neca_label\" class=\"frm_primary_label\">Preferred Language<span class=\"frm_required\">*<\/span><\/label><select name=\"item_meta[270]\" id=\"field_2neca\"  data-sectionid=\"89\"  data-placeholder=\"Select Your Language\"  placeholder=\"Select Your Language\" data-reqmsg=\"Preferred Language cannot be blank.\" aria-required=\"true\" data-invmsg=\"Preferred Language is invalid\" aria-invalid=\"false\"  ><option  class=\"frm-select-placeholder\" value=\"\" data-placeholder=\"true\">Select Your Language<\/option><option  value=\"English\">English<\/option><option  value=\"Spanish\">Spanish<\/option><option  value=\"Haitian Creole\">Haitian Creole<\/option><option  value=\"Nepali\">Nepali<\/option><option  value=\"Somali\">Somali<\/option><option  value=\"French\">French<\/option><option  value=\"Tigrinya\">Tigrinya<\/option><option  value=\"Arabic\">Arabic<\/option><option  value=\"Other\" class=\"frm_other_trigger\">Other<\/option><\/select><label for=\"field_2neca-otext\" class=\"frm_screen_reader frm_hidden\">Preferred Language<\/label><input type=\"text\" id=\"field_2neca-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][270]\" value=\"\" \/><\/div><div id=\"frm_field_283_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third vertical_radio\"><div  id=\"field_pph11_label\" class=\"frm_primary_label\">Do you need an interpreter?<span class=\"frm_required\">*<\/span><\/div><div class=\"frm_opt_container\" aria-labelledby=\"field_pph11_label\" role=\"radiogroup\" aria-required=\"true\"><div class=\"frm_radio\" id=\"frm_radio_283-89-0\"><label  for=\"field_pph11-0\"><input type=\"radio\" name=\"item_meta[283]\" id=\"field_pph11-0\" value=\"Yes\"   data-sectionid=\"89\"  data-reqmsg=\"Do you need an interpreter? cannot be blank.\" data-invmsg=\"Do you need an interpreter? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div><div class=\"frm_radio\" id=\"frm_radio_283-89-1\"><label  for=\"field_pph11-1\"><input type=\"radio\" name=\"item_meta[283]\" id=\"field_pph11-1\" value=\"No\"   data-sectionid=\"89\"  data-reqmsg=\"Do you need an interpreter? cannot be blank.\" data-invmsg=\"Do you need an interpreter? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div><\/div><div class=\"frm_description\" id=\"frm_desc_field_pph11\">*7 day notice required for interpreter<\/div><\/div><input type=\"hidden\" name=\"item_meta[392]\" id=\"field_si3tr\" value=\"\"  data-sectionid=\"89\" \/><div id=\"frm_field_110_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\"><label for=\"field_fesdh\" class=\"frm_primary_label\">Receiving WIC<span class=\"frm_required\">*<\/span><\/label><select name=\"item_meta[110]\" id=\"field_fesdh\"  data-sectionid=\"89\"  data-reqmsg=\"Receiving WIC cannot be blank.\" aria-required=\"true\" data-invmsg=\"Receiving WIC is invalid\" aria-invalid=\"false\"  ><option  value=\"\" selected='selected'> <\/option><option  value=\"Yes\">Yes<\/option><option  value=\"No\">No<\/option><option  value=\"Applied\">Applied<\/option><option  value=\"Not Eligible\">Not Eligible<\/option><\/select><\/div><div id=\"frm_field_111_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\"><label for=\"field_vqb7l\" class=\"frm_primary_label\">Receiving Medicaid<span class=\"frm_required\">*<\/span><\/label><select name=\"item_meta[111]\" id=\"field_vqb7l\"  data-sectionid=\"89\"  data-reqmsg=\"Receiving Medicaid cannot be blank.\" aria-required=\"true\" data-invmsg=\"Receiving Medicaid is invalid\" aria-invalid=\"false\"  ><option  value=\"\" selected='selected'> <\/option><option  value=\"Yes\">Yes<\/option><option  value=\"No\">No<\/option><option  value=\"Applied\">Applied<\/option><option  value=\"Not Eligible\">Not Eligible<\/option><\/select><\/div><div id=\"frm_field_112_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\"><label for=\"field_j7593\" class=\"frm_primary_label\">Medicaid Provider<span class=\"frm_required\">*<\/span><\/label><select name=\"item_meta[112]\" id=\"field_j7593\"  data-sectionid=\"89\"  data-reqmsg=\"Medicaid Provider cannot be blank.\" aria-required=\"true\" data-invmsg=\"Medicaid Provider is invalid\" aria-invalid=\"false\"  ><option  value=\"\" selected='selected'> <\/option><option  value=\"AmeriHealth Caritas\">AmeriHealth Caritas<\/option><option  value=\"Anthem\">Anthem<\/option><option  value=\"Buckeye\">Buckeye<\/option><option  value=\"CareSource\">CareSource<\/option><option  value=\"Humana Healthy Horizons\">Humana Healthy Horizons<\/option><option  value=\"Molina\">Molina<\/option><option  value=\"UnitedHealthcare Community Plan\">UnitedHealthcare Community Plan<\/option><option  value=\"I don&#039;t know\">I don&#039;t know<\/option><\/select><\/div><div id=\"frm_field_277_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third frm_other_container\"><label for=\"field_6s651\" id=\"field_6s651_label\" class=\"frm_primary_label\">How did you hear about our program?<span class=\"frm_required\">*<\/span><\/label><select name=\"item_meta[277]\" id=\"field_6s651\"  data-sectionid=\"89\"  data-reqmsg=\"How did you hear about our program? cannot be blank.\" aria-required=\"true\" data-invmsg=\"How did you hear about our program? is invalid\" aria-invalid=\"false\"  ><option  value=\"\" selected='selected'> <\/option><option  value=\"CelebrateONE\">CelebrateONE<\/option><option  value=\"CPH Website\">CPH Website<\/option><option  value=\"Doctor\/Pediatrician\">Doctor\/Pediatrician<\/option><option  value=\"Friend\/Family\">Friend\/Family<\/option><option  value=\"My Baby &amp; Me\">My Baby &amp; Me<\/option><option  value=\"Pamphlet\">Pamphlet<\/option><option  value=\"Police\/Law Enforcement\">Police\/Law Enforcement<\/option><option  value=\"Previous Class\">Previous Class<\/option><option  value=\"Social Media\/Search Engine\">Social Media\/Search Engine<\/option><option  value=\"Vineyard\">Vineyard<\/option><option  value=\"Walk In\">Walk In<\/option><option  value=\"WIC\">WIC<\/option><option  value=\"Other\" class=\"frm_other_trigger\">Other<\/option><\/select><label for=\"field_6s651-otext\" class=\"frm_screen_reader frm_hidden\">How did you hear about our program?<\/label><input type=\"text\" id=\"field_6s651-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][277]\" value=\"\" \/><div class=\"frm_description\" id=\"frm_desc_field_6s651\">Please specify<\/div><\/div><div id=\"frm_field_275_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio\"><div  id=\"field_wksug_label\" class=\"frm_primary_label\">Are you pregnant or expecting?<span class=\"frm_required\">*<\/span><\/div><div class=\"frm_opt_container\" aria-labelledby=\"field_wksug_label\" role=\"radiogroup\" aria-required=\"true\"><div class=\"frm_radio\" id=\"frm_radio_275-89-0\"><label  for=\"field_wksug-0\"><input type=\"radio\" name=\"item_meta[275]\" id=\"field_wksug-0\" value=\"Yes\"   data-sectionid=\"89\"  data-reqmsg=\"Are you pregnant or expecting? cannot be blank.\" data-invmsg=\"Are you pregnant or expecting? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div><div class=\"frm_radio\" id=\"frm_radio_275-89-1\"><label  for=\"field_wksug-1\"><input type=\"radio\" name=\"item_meta[275]\" id=\"field_wksug-1\" value=\"No\"   data-sectionid=\"89\"  data-reqmsg=\"Are you pregnant or expecting? cannot be blank.\" data-invmsg=\"Are you pregnant or expecting? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div><\/div><div class=\"frm_description\" id=\"frm_desc_field_wksug\">(If \"Yes\", don't forget to include this child below)<\/div><\/div><div id=\"frm_field_239_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\"><label for=\"field_43snj\" id=\"field_43snj_label\" class=\"frm_primary_label\">Expected Delivery Date<span class=\"frm_required\">*<\/span><\/label><input type=\"text\" id=\"field_43snj\" name=\"item_meta[239]\" value=\"\"  data-sectionid=\"89\"  maxlength=\"10\" data-reqmsg=\"Expected Delivery Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"frm_field_107_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\"><h3 class=\"frm_pos_top frm_section_spacing\">List All Children That Need Car Seats<\/h3><input type=\"hidden\" name=\"item_meta[107][form]\" value=\"10\" class=\"frm_dnc\" \/><div id=\"frm_section_107-0\" class=\"frm_repeat_sec frm_repeat_107 frm_first_repeat frm_grid_container\"><input type=\"hidden\" name=\"item_meta[107][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[107][0][0]\" value=\"\" \/><div id=\"frm_field_285-107-0_container\" class=\"frm_form_field  frm_html_container frm_field_285_container form-field\">Child <i class=\"qode_icon_font_awesome fa fa-child qode_button_icon_element\" style=\"\"><\/i><\/div><div id=\"frm_field_279-107-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio frm_field_279_container\"><div  id=\"field_ed4kb-0_label\" class=\"frm_primary_label\">Has this child been born yet?<span class=\"frm_required\">*<\/span><\/div><div class=\"frm_opt_container\" aria-labelledby=\"field_ed4kb-0_label\" role=\"radiogroup\" aria-required=\"true\"><div class=\"frm_radio\" id=\"frm_radio_279-107-0\"><label  for=\"field_ed4kb-0-0\"><input type=\"radio\" name=\"item_meta[107][0][279]\" id=\"field_ed4kb-0-0\" value=\"Yes\"   data-sectionid=\"107\"  data-reqmsg=\"Has this child been born yet? cannot be blank.\" data-invmsg=\"Has this child been born yet? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div><div class=\"frm_radio\" id=\"frm_radio_279-107-1\"><label  for=\"field_ed4kb-0-1\"><input type=\"radio\" name=\"item_meta[107][0][279]\" id=\"field_ed4kb-0-1\" value=\"No\"   data-sectionid=\"107\"  data-reqmsg=\"Has this child been born yet? cannot be blank.\" data-invmsg=\"Has this child been born yet? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div><\/div><\/div><div id=\"frm_field_70-107-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_first frm_field_70_container\"><label for=\"field_27n2y-0\" class=\"frm_primary_label\">Child's First Name<span class=\"frm_required\">*<\/span><\/label><input type=\"text\" id=\"field_27n2y-0\" name=\"item_meta[107][0][70]\" value=\"\"  data-sectionid=\"107\"  data-reqmsg=\"Child&#039;s First Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Child&#039;s First Name is invalid\" aria-invalid=\"false\"  \/><\/div><div id=\"frm_field_437-107-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_field_437_container\"><label for=\"field_jkzgb-0\" id=\"field_jkzgb-0_label\" class=\"frm_primary_label\">Date of Birth<span class=\"frm_required\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"field_jkzgb-0\" name=\"item_meta[107][0][437]\" value=\"\"  data-sectionid=\"107\"  maxlength=\"10\" data-reqmsg=\"Date of Birth cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/><\/div><input type=\"hidden\" name=\"item_meta[107][0][280]\" id=\"field_e9pu7-0\" value=\"\"  data-sectionid=\"107\" \/><div id=\"frm_field_284-107-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_first frm_field_284_container\"><label for=\"field_pk2fy-0\" id=\"field_pk2fy-0_label\" class=\"frm_primary_label\">Child's Weight<span class=\"frm_required\">*<\/span><\/label><select name=\"item_meta[107][0][284]\" id=\"field_pk2fy-0\"  data-sectionid=\"107\"  data-reqmsg=\"Child&#039;s Weight cannot be blank.\" aria-required=\"true\" data-invmsg=\"Child&#039;s Weight is invalid\" aria-invalid=\"false\"  ><option  value=\"\" selected='selected'> <\/option><option  value=\"0 - 39lbs\">0 - 39lbs<\/option><option  value=\"40lbs - 65lbs\">40lbs - 65lbs<\/option><option  value=\"Over 65lbs\">Over 65lbs<\/option><\/select><\/div><input type=\"hidden\" name=\"item_meta[107][0][86]\" id=\"field_kdzx8-0\" value=\"\"  data-sectionid=\"107\" \/><input type=\"hidden\" name=\"item_meta[107][0][293]\" id=\"field_kkn76-0\" value=\"\"  data-sectionid=\"107\" \/><input type=\"hidden\" name=\"item_meta[107][0][114]\" id=\"field_chx8b-0\" value=\"1\"  data-sectionid=\"107\"  data-frmval=\"1\"   \/><div class=\"frm_form_field frm_hidden_container frm_repeat_buttons \"><a href=\"#\" class=\"frm_add_form_row frm_button\" data-parent=\"107\" aria-label=\"Add\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" class=\"frmsvg frm-svg-icon\"><title>plus<\/title><path d=\"M15.2 9H11V4.8c0-.6-.4-.6-1-.6s-1 0-1 .6V9H4.8c-.6 0-.6.4-.6 1s0 1 .6 1H9v4.2c0 .6.4.6 1 .6s1 0 1-.6V11h4.2c.6 0 .6-.4.6-1s0-1-.6-1z\"><\/path><\/svg> Add another child<\/a><a href=\"#\" class=\"frm_remove_form_row frm_button\" data-key=\"0\" data-parent=\"107\" aria-label=\"Remove\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" class=\"frmsvg frm-svg-icon\"><title>minus<\/title><path d=\"M15.2 9H4.8c-.6 0-.6.4-.6 1s0 1 .6 1h10.4c.6 0 .6-.4.6-1s0-1-.6-1z\"><\/path><\/svg> Remove this child<\/a> <\/div><\/div><\/div><input type=\"hidden\" name=\"item_meta[290]\" id=\"field_xfufp\" value=\"\" \/><div id=\"frm_field_87_container\" class=\"frm_form_field frm_section_heading form-field \"><h3 class=\"frm_pos_top frm_section_spacing\">Household Information<\/h3><div id=\"frm_field_109_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\"><label for=\"field_mu0nz\" class=\"frm_primary_label\">Zip Code<span class=\"frm_required\">*<\/span><\/label><input type=\"number\" id=\"field_mu0nz\" name=\"item_meta[109]\" value=\"\"  data-sectionid=\"87\"  data-reqmsg=\"Zip Code cannot be blank.\" aria-required=\"true\" data-invmsg=\"Zip Code is invalid\" aria-invalid=\"false\"   min=\"10000\" max=\"99999\" step=\"1\"\/><\/div><div id=\"frm_field_77_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\"><label for=\"field_b86zg\" class=\"frm_primary_label\">Mobile\/Cell Number<span class=\"frm_required\">*<\/span><\/label><div class=\"frm_input_group frm_with_box frm_with_pre\"><span class=\"frm_inline_box\">+1<\/span><input type=\"tel\" id=\"field_b86zg\" name=\"item_meta[77]\" value=\"\"  data-sectionid=\"87\"  data-frmmask=\"9999999999\" data-reqmsg=\"Mobile\/Cell Number cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone Number is invalid\" aria-invalid=\"false\" pattern=\"\\d\\d\\d\\d\\d\\d\\d\\d\\d\\d$\"   aria-describedby=\"frm_desc_field_b86zg\"\/><\/div><div id=\"frm_desc_field_b86zg\" class=\"frm_description\">10-digit mobile number for text reminders<\/div><\/div><div id=\"frm_field_273_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_third\"><label for=\"field_x9tmx\" id=\"field_x9tmx_label\" class=\"frm_primary_label\">Email<span class=\"frm_required\"><\/span><\/label><input type=\"email\" id=\"field_x9tmx\" name=\"item_meta[273]\" value=\"\"  data-sectionid=\"87\"  data-invmsg=\"Email is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_x9tmx\"\/><div class=\"frm_description\" id=\"frm_desc_field_x9tmx\">*email provided will be used for Car Seat Program communications only<\/div><\/div><input type=\"hidden\" name=\"item_meta[299]\" id=\"field_rj1vk-0\" value=\"\"  data-sectionid=\"87\" \/><div id=\"frm_field_499_container\" class=\"frm_form_field form-field  frm_top_container\"><label for=\"field_m0hvh\" id=\"field_m0hvh_label\" class=\"frm_primary_label\">Comments \/ Special Requests<span class=\"frm_required\" aria-hidden=\"true\"><\/span><\/label><textarea name=\"item_meta[499]\" id=\"field_m0hvh\" rows=\"5\"  data-sectionid=\"87\"  data-invmsg=\"Paragraph is invalid\" aria-invalid=\"false\"  ><\/textarea><div class=\"frm_pro_max_limit_desc\" data-max=\"150\" data-max-type=\"word\"><span id=\"frm_pro_content_length_499\">0<\/span> of 150 max words<\/div><\/div><input type=\"hidden\" name=\"item_meta[82]\" id=\"field_b90tl\" value=\"\"  data-sectionid=\"87\" \/><input type=\"hidden\" name=\"item_meta[393]\" id=\"field_n4hmw\" value=\"\"  data-sectionid=\"87\" \/><\/div><div id=\"frm_field_148_container\" class=\"frm_form_field frm_section_heading frm_hidden frm_invisible_section form-field \"><h3 class=\"frm_pos_top frm_section_spacing\">Follow-up<\/h3><div id=\"frm_field_145_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_half frm_other_container\"><label  class=\"frm_primary_label\">Ethnicity<span class=\"frm_required\"><\/span><\/label><div class=\"frm_opt_container\"><select name=\"item_meta[145]\" id=\"field_rojwq\"  data-sectionid=\"148\"  data-invmsg=\"Ethnicity is invalid\" aria-invalid=\"false\"  ><option  value=\"\" selected='selected'> <\/option><option  value=\"African American\">African American<\/option><option  value=\"Asian\">Asian<\/option><option  value=\"Caucasian\">Caucasian<\/option><option  value=\"Hispanic\">Hispanic<\/option><option  value=\"Somali\">Somali<\/option><option  value=\"Other\" class=\"frm_other_trigger\">Other<\/option><\/select><label for=\"field_rojwq-otext\" class=\"frm_screen_reader frm_hidden\">Ethnicity<\/label><input type=\"text\" id=\"field_rojwq-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][145]\" value=\"\" \/><\/div><\/div><div id=\"frm_field_144_container\" class=\"frm_form_field form-field  frm_top_container frm_half\"><label for=\"field_1tzqr\" class=\"frm_primary_label\">Attendance<span class=\"frm_required\"><\/span><\/label><select name=\"item_meta[144]\" id=\"field_1tzqr\"  data-sectionid=\"148\"  data-invmsg=\"Attendance is invalid\" aria-invalid=\"false\"  ><option  value=\"\" selected='selected'> <\/option><option  value=\"Attended\">Attended<\/option><option  value=\"Did Not Attend\">Did Not Attend<\/option><option  value=\"Cancelled\">Cancelled<\/option><\/select><\/div><\/div><div id=\"frm_field_310_container\" class=\"frm_form_field frm_section_heading frm_hidden frm_invisible_section form-field \"><h3 class=\"frm_pos_top frm_section_spacing\">Payment<\/h3><div id=\"frm_field_312_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_fourth\"><label for=\"field_aqark\" id=\"field_aqark_label\" class=\"frm_primary_label\">Amount Paid<span class=\"frm_required\"><\/span><\/label><input type=\"text\" id=\"field_aqark\" name=\"item_meta[312]\" value=\"\"  data-sectionid=\"310\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><\/div><div id=\"frm_field_313_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth vertical_radio\"><div  id=\"field_9xuw2_label\" class=\"frm_primary_label\">Payment Type<span class=\"frm_required\"><\/span><\/div><div class=\"frm_opt_container\" aria-labelledby=\"field_9xuw2_label\" role=\"radiogroup\"><div class=\"frm_radio\" id=\"frm_radio_313-310-0\"><label  for=\"field_9xuw2-0\"><input type=\"radio\" name=\"item_meta[313]\" id=\"field_9xuw2-0\" value=\"Cash\"   data-sectionid=\"310\"  data-invmsg=\"Payment Type is invalid\" aria-invalid=\"false\"  \/> Cash<\/label><\/div><div class=\"frm_radio\" id=\"frm_radio_313-310-1\"><label  for=\"field_9xuw2-1\"><input type=\"radio\" name=\"item_meta[313]\" id=\"field_9xuw2-1\" value=\"Check\"   data-sectionid=\"310\"  data-invmsg=\"Payment Type is invalid\" aria-invalid=\"false\"  \/> Check<\/label><\/div><\/div><\/div><div id=\"frm_field_314_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\"><label for=\"field_85gkk\" id=\"field_85gkk_label\" class=\"frm_primary_label\">Check Number<span class=\"frm_required\">*<\/span><\/label><input type=\"text\" id=\"field_85gkk\" name=\"item_meta[314]\" value=\"\"  data-sectionid=\"310\"  data-reqmsg=\"Check Number cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><\/div><\/div><input type=\"hidden\" name=\"item_meta[116]\" id=\"field_dxmv0\" value=\"\" \/><input type=\"hidden\" name=\"item_meta[296]\" id=\"field_6nsoc\" value=\"\" \/><input type=\"hidden\" name=\"item_meta[94]\" id=\"field_v84z2\" value=\"\" data-frmval=\"\"\/><input type=\"hidden\" name=\"item_meta[286]\" id=\"field_k50nq\" value=\"\" \/><input type=\"hidden\" name=\"item_meta[358]\" id=\"field_7jnn3\" value=\"1\"  data-frmval=\"1\"   \/><input type=\"hidden\" name=\"item_meta[395]\" id=\"field_ozaao\" value=\"\" \/><input type=\"hidden\" name=\"item_meta[397]\" id=\"field_tegb\" value=\"\" \/><input type=\"hidden\" name=\"item_meta[401]\" id=\"field_zd98c\" value=\"\" \/><input type=\"hidden\" name=\"item_meta[359]\" id=\"field_vxkmt\" value=\"\" \/><input type=\"hidden\" name=\"item_key\" value=\"\" \/><div class=\"frm__656e0f7b99104\"><label for=\"frm_email_6\" >If you are human, leave this field blank.<\/label><input  id=\"frm_email_6\" type=\"text\" class=\"frm_verify\" name=\"frm__656e0f7b99104\" value=\"\" autocomplete=\"off\"  \/><\/div><input name=\"frm_state\" type=\"hidden\" value=\"h+EOLNPPv4kvI2gQUeY7j5\/fJMUZaEapSEpAQb3d9PE7k6Gm\/AF4xz7yByLzc6P9KTPfk+Vko+7Er4ipvKe1LKIuME33+8hPQDcHZz85bFmNrb+HKtsmOCtgJz4SkwtJ\" \/><div class=\"frm_submit\"><input type=\"submit\" value=\"Submit Class Registration\"  class=\"frm_final_submit\" formnovalidate=\"formnovalidate\" \/><img decoding=\"async\" class=\"frm_ajax_loading\" src=\"https:\/\/cphsystems.org\/car-seats\/wp-content\/plugins\/formidable\/images\/ajax_loader.gif\" alt=\"Sending\"\/><\/div><\/div><\/fieldset><\/div><\/form><\/div>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;full_width&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221; css_animation=&#8221;&#8221; css=&#8221;.vc_custom_1614376279880{padding-top: 50px !important;padding-right: 50px !important;padding-bottom: 50px !important;padding-left: 50px !important;background-color: #ffffff !important;}&#8221;][vc_column][vc_column_text][\/vc_column_text][\/vc_column][\/vc_row][vc_row row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;full_width&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221; css_animation=&#8221;&#8221; css=&#8221;.vc_custom_1614376648238{margin-top: 0px !important;padding-right: 50px [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1145,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1231","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/cphsystems.org\/car-seats\/wp-json\/wp\/v2\/pages\/1231","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cphsystems.org\/car-seats\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cphsystems.org\/car-seats\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cphsystems.org\/car-seats\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cphsystems.org\/car-seats\/wp-json\/wp\/v2\/comments?post=1231"}],"version-history":[{"count":15,"href":"https:\/\/cphsystems.org\/car-seats\/wp-json\/wp\/v2\/pages\/1231\/revisions"}],"predecessor-version":[{"id":2019,"href":"https:\/\/cphsystems.org\/car-seats\/wp-json\/wp\/v2\/pages\/1231\/revisions\/2019"}],"up":[{"embeddable":true,"href":"https:\/\/cphsystems.org\/car-seats\/wp-json\/wp\/v2\/pages\/1145"}],"wp:attachment":[{"href":"https:\/\/cphsystems.org\/car-seats\/wp-json\/wp\/v2\/media?parent=1231"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}